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Factors associated with physiotherapy prescription among adult patients consulting for musculoskeletal
disorders in primary care
Matthieu Peurois, Aline Ramond-Roquin, Najia Adjeroud, Mélanie Bertin, Natacha Fouquet, Yves Roquelaure
To cite this version:
Matthieu Peurois, Aline Ramond-Roquin, Najia Adjeroud, Mélanie Bertin, Natacha Fouquet, et al..
Factors associated with physiotherapy prescription among adult patients consulting for musculoskeletal disorders in primary care. 47th North American Primary Care Research Group (NAPCRG) annual meeting, Nov 2019, Toronto, Canada. �hal-02480823�
Factors associated with physiotherapy prescription among adult patients consulting for musculoskeletal disorders in primary care
Peurois M1-2, Bertin M1, Adjeroud N2, Fouquet N3, Roquelaure Y1,Ramond-Roquin A1-2-4
Introduction
Musculoskeletal disorders : a public health issue
- 50 % of European workers, 12.6% of General Practicionners (GP’s) consultations (2014)
- 50 % of occupational accidents, 87% of occupational diseases - 3 % of french GDP (care costs, absenteism…)
Objectives
To explore factors associated with physiotherapy prescription among adult patients consulting for musculoskeletal disorders in primary care at the patient’s, GP’s and contextual levels
Bio-psycho-social management - Physiotherapy prescription
8.5 % of the whole GP’s prescriptions
Initiated mainly by GPs (76.1 %)
Design and database
- ECOGEN (Elements of COnsultation in GENeral practice)
Cross-sectionnal multicenter French national study in November 2011 / April 2012
128 GPs
- Hierarchical data collection
Reason for encounter, consultation results and healthcare procedures coded with ICPC-2 (WONCA, 1998)
Data about patients, GPs et consultation context
Inclusion criteria
- 18 / 65 years-old
- Consulting for MSDs without traumatic, infection, inflammatory or tumoral issues
Codes ICPC-2 :
- 26 codes L (Locomotor) - 3 codes N (Neurological)
Methods
Contextual variables calculation with postal patients codes
Geographical area « Bassins de vie » (1 666 in France, 2012)
16 equipements/31 among public, health, education and occupational services
Potential localized accessibility (PLA) for GP and physiotherapist ( 2012)
PLA = 1 1 full-time healthcare professionnal in a 15 min distance perimeter
French Deprivation index (FDep, Rey et al. 2009) - % of unemployed - % of workers
- % of bachelor - monthly median incomes
- Multilevel logistical Regression (128 GPs et 62 geographical areas)
Marginal model or population-average : Generalized Estimating Equations (GEE)
Sensitivity analyses with fixed-effect and random-effect mixed models
Statistical analyses
- Multidimensional exploratory analyses
Multiple correspondance analysis (MCA) and hierarchical ascending classification (HAC) Only using patients’ variables
Results Multilevel ajusted logistic regression
OR (CI 95%) p-value
Patient’s variables Age
35-50 years-old
>50 years-old
0.78 (0.58-1.04) 0.69 (0.52-0.91)
0.084 0.008
Gender female 1.28 (1.03-1.59) 0.024
Number of healthcare procedures
4-6
>6
0.73 (0.57-0.93) 0.68 (0.50-0.94)
0.013 0.018 GP’s variables
Age > 50 years-old 0.50 (0.39-0.63) <0.001
Practice location Semi-urban
Urban
0.62 (0.42-0.90) 0.84 (0.58-1.21)
0.013 0.344 Type of exercice
Group
Multidisciplinary team
0.98 (0.74-1.30) 0.62 (0.43-0.90)
0.902 0.011 Number of consultations
>5000 by year
0.79 (0.63-0.99) 0.038
Geographical variables French Deprivation index Q2
Q3 Q4
0.73 (0.52-1.00) 0.61 (0.41-0.90) 0.60 (0.40-0.90)
0.053 0.013 0.013
Spine symptoms 1.47 (1.18-1.83) <0.001
Shoulder symptoms 1.66 (1.20-2.29) 0.002
1Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France
2Univ Angers, Department of General Practice, France
3Santé publique France, the French National Public Health Agency, Direction of Occupational Health, EpiprevTMS team associated to the University of Angers, Angers, France
4Univ Sherbrooke, Family and emergency medicine department, associated professor, Quebec, Canada
Mixed models : Similar results
Spine model : Similar results, with low physiotherapist accessibility as contextual factor associated with less physiotherapy prescription
Flow chart
- Physiotherapy prescription is associated with patient’s, GP’s and contextual factors
- Pertinence of contextual approach using healthcare professional accessibilities and deprivation markers in general practice setting
- Use of multilevel analyses in primary care for other healthcare professional or contextual issues
Health inequalities reduction approach
47th North American Primary Care Research Group (NAPCRG) annual meeting – Toronto – 16th to 20th November 2019
